Computer simulation firms in Florida are playing doctor

Soon, perhaps as early as November, U. S. Air Force medics who train at Camp Bullis in Texas should get to play a new video game.

Dubbed “STAT ER,” the game will put them inside a gray medical tent in the middle of nowhere, where four soldiers have just been rushed in following a mass-casualty event. The solders will writhe in pain and plead for help — one may have just lost a leg and be bleeding to death, while another wheezes and complains of chest pain. As the medics decide which soldier to treat first and how to proceed, a timer ticks and patient monitors beep. One of the soldiers Will flatline in less than six minutes if the medic can’t make the correct decisions.

STAT ER was created by Vcom3D, an Orlando simulation company founded by a pair of former General Electric executives. The company, a small-business military contractor with less than $7.5 million a year in revenue, has a lot riding on the success of the game and other medical simulators like it.

“We’ve really committed the success of the company to the medical (field),” says Carol Wideman, Vcom3D’s CEO and one of the co-founders.

Across much of Florida’s modeling, simulation and training industry — a $4.8-billion cluster heavily concentrated around the University of Central Florida in east Orange County — companies see medical simulation as ripe with potential, not just from the military and other government agencies, but from commercial clients, too.

There are plenty of signs of growth. Orlando now hosts a “Medical Technology, Training & Treatment (MT3) Conference,” which organizers bill as the industry’s premier health care technology tradeshow. The 4-year-old medical school at UCF was the first in the nation to integrate simulation into its curriculum, according to local economic development officials. And Florida Hospital this year gave $1 million to UCF’s College of Nursing to set up an endowed chair for health care simulation.

A key part of the region’s medical simulation hotbed is the health and life sciences cluster emerging around “Medical City,” a 625-acre commercial development in Lake Nona 18 miles southeast of downtown Orlando. The cluster began with the heavily subsidized Sanford Burnham Medical Research Institute, which opened in 2009, and now includes the UCF medical school (opened 2010), a University of Florida research center (2012) and a Nemours children’s hospital (2012). A $665-million, 1.2 million-sq.-ft. Department of Veteran Affairs hospital is expected to fully open next year.

The simulation companies’ move into the civilian sector also reflects the need to hedge against their dependence on military spending, the industry’s current lifeblood. Long-running wars in Afghanistan and the Middle East are winding down, and Congress and the White House are imposing budget cuts.

The Army’s training contracts agency in Orlando — known as the Program Executive Office for Simulation, Training and Instrumentation, or “PEO-STRI” — has cut more than two dozen jobs in recent months, including more than 40% of its contracting officers, according to a recent report in the Orlando Sentinel.

“We’re worried that because of political or other reasons that the Army may get diminished or pull out of here,” says Beverly Seay, a University of Central Florida trustee and a former vice president at CAE, the international manufacturer of simulation and training equipment whose American health care division is based in Sarasota.

Seay called the growth of medical simulation “a wonderful example of how modeling and simulation and defense is moving into other critical areas.”

Vcom3D’s trajectory illustrates that evolution clearly. Founded in 1997, the company began by focusing on armor and terrain simulation and interactive avatars. Its big break came in 2007, when it developed the “VCommunicator” — an iPod-based mobile translation device and culture aid for use by soldiers and others in places like the Middle East and Africa.

Based on technology developed to teach sign language to students, it became a popular product throughout the U. S. military, as well as at the United Nations. Demand was so high at one point that the company turned a room at its corporate offices into a makeshift assembly line, where company employees worked furiously to adapt storebought iPods.

Around 2009, as interest in the Vcommunicator ebbed, Vcom3D had to decide where to invest its resources. The firm chose to target medical simulation, partly because of the commercial potential — cities, counties, private ambulance operators, hospitals, doctors and nurses are all potential customers.

Company personnel spent several years learning about the field and identifying potential clients and their needs. Vcom3D representatives even met with hospital personnel who handled victims following the Boston Marathon bombings in April 2013. The company is now developing a suite of training games simulating each step of care — from emergency-medical technician response to emergency rooms and intensive care units. The company will try to commercialize the ICU simulation first, in part because it has the largest pool of potential customers.

The goal is to replicate the high-stress, open-ended situations that medical personnel are confronted with in real life. Demonstrating the emergency room simulation, Dan Silverglate, the company’s director of software and graphics development, says, “It’s very dynamic. There are a lot of successful paths for each patient. And there are some unsuccessful paths.”

Even the successful paths aren’t equally successful, he points out. One sequence of choices might ultimately lead to a full recovery, while another will save the patient but leave him with long-term injury or disability.

While Vcom3D clearly hopes it has another Vcommunicator on its hands, Wideman says the decision to dive into medical simulation isn’t driven purely by profit. It’s also about working on something in which employees can take pride — like a product ultimately designed to improve medical care.

“There is that thread in the company where we want to do something that’s good for people,” she says.

The Future of Training

Professor Greg Welch, a computer scientist at UCF, was selected earlier this year to become the first Florida Hospital Endowed Chair in Healthcare Simulation, housed in UCF’s college of nursing.

By cross-pollinating disciplines such as computer science and engineering with medicine and nursing, Welch hopes to eventually identify new technological possibilities to improve training and, ultimately, reduce medical errors — which kill between 210,000 and 410,000 people per year, according to one recent study.

Welch says he envisions a day when it is possible to make incredibly sophisticated mannequins — “surrogates for human patients” — that can mimic humans in every way, from basic anatomy to emotional responses, and that can be used to practice everything from drawing blood to certain surgical procedures. The realism would extend all the way down to the mannequin’s skin, which would turn pale when someone pushes down on it with a finger and then rapidly return to normal when the finger is removed.

“There’s a lot that’s been done, and it’s really great. There are some things that are relatively low-hanging fruit that people are grabbing at,” Welch says. “There are some things that I want to focus on that are much more diffcult but would have tremendous payoff, if we could succeed,” Welch says.

“Today’s mannequins and human-based simulators can do some of these things, can simulate bits and pieces,” he adds. “But I really look forward to when it’s all able to be integrated, all the bits and pieces together.”

A ‘Virtual’ VA

Among the companies diving into medical simulation, Engineering & Computer Simulations — named the national Small Business of the Year in 2010 by the U.S. Small Business Administration — has a host of medical projects in its pipeline.

One — a partnership with fellow Orlando small businesses SIMETRI of Winter Park and ArtSimMagic of Orlando — is a rugged, portable mannequin that feels lifelike to the touch but is and cameras that transmit wirelessly to a computer or mobile device. The mannequin is what’s known as a “part-task trainer,” meant to teach a specific medical task — in this case a procedure meant to allow oxygen to escape someone’s body if the lung has been punctured and is leaking internally.

At the same time, through a $2.5-million contract with the Department of Veterans Affairs, ECS is developing a “virtual” VA medical center: A fully realized replica of a veterans hospital that patients will be able to access online and with their own avatars. The hope is that the online hospital can alleviate congestion at the VA’s real-world facilities by giving patients a place to turn for questions, research, seminars and even consultations with physicians. The virtual hospital is expected to go live on Oct.1 at vavmc.com.

ECS President Waymon Armstrong says he hopes to eventually commercialize the technology, too. Already, he says the company is talking with a major insurance company and a hospital chain that have expressed interest in the concept, though he says he cannot yet name them.

Cuts — Large and Small

Florida came out ahead the last time the nation realigned and closed U.S. military bases in 2005, but state and local economic developers always worry about what another round will bring to a state with such a large military presence. The Obama administration and the Pentagon have wanted to schedule another Base Realignment and Closure (BRAC) round for several years, arguing that money needed for readiness and modernization is being blown on unneeded infrastructure. But they’ve been stymied by Congress, whose members want to hold on to home district military and civilian jobs and spending. Indeed, Congress has Prohibited another BRAC.

It’s possible a lame-duck session after the November election will produce a different outlook. And bases aren’t immune from cuts just because the Pentagon can’t get a BRAC process started. The Defense Department still faces $487 billion in cuts over 10 years under the sequester. The department by law has to notify Congress if it plans on its own to close a base or significantly cut employment at a facility, but the Pentagon can act unilaterally on smaller installations and can shrink employment gradually at others — eventually reducing them below the thresholds where it can act on its own. — Mike Vogel